Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1075–1081 | Cite as

Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients

  • Charles M. Balch
  • John F. Thompson
  • Jeffrey E. Gershenwald
  • Seng-jaw Soong
  • Shouluan Ding
  • Kelly M. McMasters
  • Daniel G. Coit
  • Alexander M. M. Eggermont
  • Phyllis A. Gimotty
  • Timothy M. Johnson
  • John M. Kirkwood
  • Stanley P. Leong
  • Merrick I. Ross
  • David R. Byrd
  • Alistair J. Cochran
  • Martin C. MihmJr
  • Donald L. Morton
  • Michael B. Atkins
  • Keith T. Flaherty
  • Vernon K. Sondak



We have previously reported that older patients with clinical stage I and II primary cutaneous. Melanoma had lower survival rates compared to younger patients. We postulated that the incidence of nodal metastasis would therefore be higher among older melanoma patients.


The expanded American Joint Committee on Cancer melanoma staging database contains a cohort of 7,756 melanoma patients who presented without clinical evidence of regional lymph node or distant metastasis and who underwent a sentinel node biopsy procedure as a component of their staging assessment.


Although older patients had primary melanoma features associated with more aggressive biology, we paradoxically observed a significant decrease in the incidence of sentinel node metastasis as patient age increased. Overall, the highest incidence of sentinel node metastasis was 25.8 % in patients under 20 years of age, compared to 15.5 % in patients 80 years and older (p < 0.001). In contrast, 5-year mortality rates for clinical stage II patients ranged from a low of 20 % for those 20–40 years of age up to 38 % for those over 70 years of age. Patient age was an independent predictor of sentinel node metastasis in a multifactorial analysis (p < 0.001).


Patients with clinical stage I and II melanoma under 20 years of age had a higher incidence of sentinel lymph node metastasis but, paradoxically, a more favorable survival outcome compared to all other age groups. In contrast, patients >70 years had the most aggressive primary melanoma features and a higher mortality rate compared to all other age groups but a lower incidence of sentinel lymph node metastasis.



The work of the AJCC/UICC Melanoma Staging Committee was supported by a Grant from the AJCC and by Grants from the National Cancer Institute (P30 CA13148 at the University of Alabama at Birmingham and P50 CA93459 SPORE Grant in melanoma at The University of Texas M. D. Anderson Cancer Center in Houston, TX, USA). Three meetings held by the committee were partially supported by an unrestricted educational Grant from Schering-Plough (Kenilworth, NJ, USA).


The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Charles M. Balch
    • 1
  • John F. Thompson
    • 2
  • Jeffrey E. Gershenwald
    • 3
  • Seng-jaw Soong
    • 4
  • Shouluan Ding
    • 4
  • Kelly M. McMasters
    • 5
  • Daniel G. Coit
    • 6
  • Alexander M. M. Eggermont
    • 7
  • Phyllis A. Gimotty
    • 8
  • Timothy M. Johnson
    • 9
  • John M. Kirkwood
    • 10
  • Stanley P. Leong
    • 11
  • Merrick I. Ross
    • 3
  • David R. Byrd
    • 12
  • Alistair J. Cochran
    • 13
  • Martin C. MihmJr
    • 14
  • Donald L. Morton
    • 15
  • Michael B. Atkins
    • 16
  • Keith T. Flaherty
    • 17
  • Vernon K. Sondak
    • 18
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Melanoma Institute AustraliaNorth SydneyAustralia
  3. 3.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.University of Alabama at BirminghamBirminghamUSA
  5. 5.Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  6. 6.Memorial Sloan-Kettering Cancer CenterNew YorkUSA
  7. 7.Cancer Institute Gustave RoussyVillejuifFrance
  8. 8.Department of Biostatistics and EpidemiologyUniversity of PennsylvaniaPhiladelphiaUSA
  9. 9.Department of DermatologyUniversity of Michigan Comprehensive Cancer CenterAnn ArborUSA
  10. 10.Division of Oncology, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  11. 11.Department of SurgeryCalifornia Pacific Medical Center and Research InstituteSan FranciscoUSA
  12. 12.Department of SurgeryUniversity of WashingtonSeattleUSA
  13. 13.Departments of Pathology and Laboratory Medicine and SurgeryUCLA School of MedicineLos AngelesUSA
  14. 14.Department of PathologyDana-Farber Cancer InstituteBostonUSA
  15. 15.John Wayne Cancer InstituteSanta MonicaUSA
  16. 16.Lombardi Comprehensive Cancer CenterMedstar Georgetown University HospitalWashingtonUSA
  17. 17.Division of Hematology/Oncology, Department of MedicineMassachusetts General HospitalBostonUSA
  18. 18.Division of Cutaneous OncologyH. Lee Moffitt Cancer CenterTampaUSA

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